2019
DOI: 10.1001/jamasurg.2018.2446
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Risk Calculators and Decision Aids Are Not Enough for Shared Decision Making

Abstract: Surgical decision making is not all about risk. Surgeons must weigh anticipated outcomes against expected burdens when contemplating decisions between surgery or no surgery. 1 Developing a strategy for managing surgical problems and honoring patient priorities requires this calculation using a process of shared decision making. Although the tools to support surgical decision making have improved over time, the ability of surgeons to engage patients in shared decision making depends on their ability to use thes… Show more

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Cited by 44 publications
(42 citation statements)
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“…11 Therefore, there is a need for better solutions that focus on nonlinear variables. 12 Deep learning networks can learn the highly intricate and linear/nonlinear associations between prognostic clinical characteristics and an individual's risk of death from LCSS. 13 In application, these networks have even shown potential for providing individual recommendations based on the calculated risk.…”
Section: Introductionmentioning
confidence: 99%
“…11 Therefore, there is a need for better solutions that focus on nonlinear variables. 12 Deep learning networks can learn the highly intricate and linear/nonlinear associations between prognostic clinical characteristics and an individual's risk of death from LCSS. 13 In application, these networks have even shown potential for providing individual recommendations based on the calculated risk.…”
Section: Introductionmentioning
confidence: 99%
“…Ultimately, the broader goal should be for clinicians and patients to engage in a meaningful exchange to determine a course of action together, one that works best for each patient . Decision aids and similar tools need to be accompanied by dialogue between surgeons and patients about patients' hopes and goals . Indeed, emphasizing technical aspects of SDM, such as providing information, remains the norm while humanistic aspects, such as displaying empathy and compassion, are rarely employed .…”
Section: Resultsmentioning
confidence: 99%
“…[23][24][25] Decision aids and similar tools need to be accompanied by dialogue between surgeons and patients about patients' hopes and goals. 26 Indeed, emphasizing technical aspects of SDM, such as providing information, remains the norm while humanistic aspects, such as displaying empathy and compassion, are rarely employed. 27 Using interviews and real-life observations, our study identifies important barriers to achieving a rich SDM dialogue.…”
Section: Case #2: Goals At Odds: Assessing Expertise and Explainingmentioning
confidence: 99%
“…It is imperative to determine what matters most to patients from them directly, their loved ones, or a combination of the two (136,147). Merely applying patient decision aids to surgical risk calculations are inadequate (148). Abstract patient values must be elicited (59,60,(149)(150)(151)(152) and concatenated with evidence-based clinical knowledge, such as prognosis and risk calculations, for surgical decisions to be truly shared (67,148).…”
Section: Surgery Palliative Carementioning
confidence: 99%
“…Merely applying patient decision aids to surgical risk calculations are inadequate (148). Abstract patient values must be elicited (59,60,(149)(150)(151)(152) and concatenated with evidence-based clinical knowledge, such as prognosis and risk calculations, for surgical decisions to be truly shared (67,148). Responding to patient/family emotion should occur throughout all conversations.…”
Section: Surgery Palliative Carementioning
confidence: 99%